Newly published research from the University of Bristol highlights a clear opportunity for the NHS to improve outcomes by strengthening internal consultancy and reducing reliance on external providers.

The research identifies that over-reliance on external consultants remains a persistent challenge, often leading to dependency and inconsistent value. Instead, the report shows that the most effective approach is a “blended” consultancy model—combining the strengths of internal expertise with targeted external support when needed. In this model:

• Internal consulatants provide essential context, continuity, and deep system understanding
• External consultants contribute specialist skills and additional capacity where required

The key message is clear: external consultancy should be used selectively and as a complement—not as the default approach.

A shift in approach

The report concludes that the NHS can significantly improve value, sustainability, and performance by moving away from heavy reliance on external consultants and towards a stronger, more coordinated internal consulting model, supported by carefully targeted external expertise.

How MIAA supports this shift

MIAA is proud to support this direction of travel. We provide expert, insight-led consultancy that not only delivers immediate results but also builds lasting capability within NHS organisations.

To explore the findings in more detail, you can read the full report here:
 NHS Internal Management Consulting Report_DIGITAL final.pdf